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LOGIN REQUEST FORM
USER INFORMATION
Contact Name
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Email Address
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Phone Number
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ADDRESS INFORMATION
Address
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02-42001 - URGENT TEAM - 30 Burton Hills Blvd - Suite 175 - Nashville - TN - 37215
25-51107 - URGENT TEAM - VALERO - 324 W. Mallory Ave. - Memphis - TN - 38109
09-04101 - SHERWOOD URGENT CARE - 610 Shepherd Way - Searcy - AR - 72143
09-04102 - SHERWOOD URGENT CARE - 1547 E. Harrison St. - Batesville - AR - 72501
09-04105 - SHERWOOD URGENT CARE - 1306 N. Center St. - Lonoke - AR - 72086
09-04106 - SHERWOOD URGENT CARE - 6134 Heber Springs Rd. - Quitman - AR - 72131
12-04201 - BAPTIST HEALTH URGENT CARE - 3550 Springhill Dr. - North Little Rock - AR - 72117
12-04202 - BAPTIST HEALTH URGENT CARE - 3304 Commonwealth Dr. - Bryant - AR - 72022
12-04203 - BAPTIST HEALTH URGENT CARE - 1813 TP White Dr. - Jacksonville - AR - 72076
12-04204 - BAPTIST HEALTH URGENT CARE - 6805 Cantrell Rd. - Little Rock - AR - 72207
12-04205 - BAPTIST HEALTH URGENT CARE - 824 Military Rd. - Benton - AR - 72015
12-04206 - BAPTIST HEALTH URGENT CARE - 402 W. Main St. - Cabot - AR - 72023
12-04207 - BAPTIST HEALTH URGENT CARE - 7600 Rogers Ave. - Fort Smith - AR - 72903
12-04208 - BAPTIST HEALTH URGENT CARE - WESTLR - 14524 Cantrell Rd. - Suite 160 - Little Rock - AR - 72223
12-04209 - Baptist Health URGENT CARE - 2069 W. Center Street - Beebe - AR - 72012
12-04210 - Baptist Health Urgent Care - Zero. St, Fort Smith - 1910 S. Zero St. - Fort Smith - AR - 72901
12-04211 - Baptist Health Urgent Care - Markham - 11402 W. Markham St. - Little Rock - AR - 72211
12-04212 - BAPTIST HEALTH URGENT CARE - NORTHSIDE - 2801 ROGERS AVENUE - Fort Smith - AR - 72901
12-04213 - BAPTIST HEALTH URGENT CARE - VAN BUREN - 1902 Fayetteville Road - Van Buren - AR - 72956
12-04214 - Baptist Health Urgent Care - 222 Dave Ward Dr. - Conway - AR - 72032
12-04215 - Baptist Health Urgent Care - 106 Weir Rd - Suite 4 - Russellville - AR - 72802
12-04216 - Baptist Health Urgent Care - 123 Audubon Dr - Suite 600 - Maumelle - AR - 72113
12-04217 - Baptist Health Urgent Care - 1065 Sklyline Dr - Conway - AR - 72032
12-04218 - Baptist Health Urgent Care - 201 Airport Rd - Hot Springs - AR - 71913
12-04219 - BAPTIST HEALTH URGENT CARE - 511 W. Main Street - Russellville - AR - 72801
12-04220 - BAPTIST HEALTH URGENT CARE - 3426 Central Avenue - Hot Springs - AR - 71913
14-42202 - PHYSICIANS CARE - 455 Chickamauga Dr. - Ste 104 - Dayton - TN - 37321
14-42203 - PHYSICIANS CARE - 403 McBrien Rd. - East Ridge - TN - 37412
14-42204 - PHYSICIANS CARE - HAMILTON - 2021 Hamilton Place Blvd. - Building G - Chattanooga - TN - 37421
14-42205 - PHYSICIANS CARE - HWY58 - 4747 Hwy 58 - Chattanooga - TN - 37416
14-42206 - PHYSICIANS CARE - 4490 Hixson Pike - Hixson - TN - 37343
14-42207 - URGENT TEAM - 524 Market Drive - Lenior City - TN - 37771
14-42208 - URGENT TEAM - 625 E 12th St. - S. Pittsburg - TN - 37380
14-42209 - PHYSICIANS CARE - NORTHSHORE - 419 N. Market St. - Ste 100 - Chattanooga - TN - 37405
14-42210 - URGENT TEAM - 525 W. Broadway Ave. - Maryville - TN - 37801
14-42211 - URGENT TEAM - 2636 W. Andrew Johnson Hwy - Morristown - TN - 37814
14-42212 - URGENT TEAM - 6942 Maynardville Pike - Knoxville - TN - 37918
15-26110 - Physicians Care - Hoover S - 1989 Montgomery Hwy - Hoover - AL - 35244
15-26111 - Physicians Care - Hoover N - 1539 Montgomery Hwy. - Suite 101 - Hoover - AL - 35216
17-27101 - HUNTSVILLE HOSPITAL URGENT CARE - 210 Avalon Ave. - Muscle Shoals - AL - 35661
17-27102 - HUNTSVILLE HOSPITAL URGENT CARE - 900 Bob Wallace Ave. - Ste 104 - Huntville - AL - 35801
17-27103 - HUNTSVILLE HOSPITAL URGENT CARE - 202 Cox Creek Parkway - Florence - AL - 35630
17-27104 - HUNTSVILLE HOSPITAL URGENT CARE - 1115 Beltline Road SE - Suite 400 - Decatur - AL - 35601
17-27105 - HUNTSVILLE HOSPITAL URGENT CARE - 300 Hughes Rd - Suite G2 - Madison - AL - 35758
17-27106 - Huntsville Hospital Urgent Care - 1311 2nd Ave. SW - Suite A - Cullman - AL - 35055
17-27107 - Huntsville Hospital Urgent Care - Bailey Cove - 7216 Bailey Cove Road SE - Suite A - Huntsville - AL - 35802
17-27108 - Huntsville Hospital Urgent Care - 14451 Hwy. 231 - Hazel Green - AL - 35750
17-27109 - Huntsville Hospital Urgent Care - ATHENS - 22175 Hwy 72 - Suite B - Athens - AL - 35613
19-30101 - PHYSICIANS CARE - 400 Battlefield Pkwy. - Ft. Oglethorpe - GA - 30742
19-30102 - PHYSICIANS CARE - 1209 W. Walnut Ave - Suite 1 - Dalton - GA - 30720
21-04301 - WASHINGTON REGIONAL URGENT CARE - 2301 W. Pleasant Grove Rd - Ste 101 - Rogers - AR - 72758
21-04302 - WASHINGTON REGIONAL URGENT CARE - 1301 S. Walton Blvd. - Bentonville - AR - 72712
21-04303 - WASHINGTON REGIONAL URGENT CARE - 808 US-65 - Harrison - AR - 72601
21-04304 - WASHINGTON REGIONAL URGENT CARE - 3300 W. Sunset Ave. - Springdale - AR - 72762
21-04305 - Washington Regional UC - Fayetteville - 2069 N. Crossover Road - Suite 2 - Fayetteville - AR - 72703
23-44103 - ASCENSION SAINT THOMAS-URGENT CARE - MURF MEM - 2445 Memorial Blvd - Suite C - Murfreesboro - TN - 37129
23-44107 - ASCENSION SAINT THOMAS-URGENT CARE - 2006 Memorial Blvd - Suite 101 - Springfield - TN - 37172
23-44111 - ASCENSION SAINT THOMAS-URGENT CARE - 1802 N. Jackson St. - Suite 850 - Tullahoma - TN - 37388
23-44113 - ASCENSION SAINT THOMAS-URGENT CARE - FT. CAMP - 1690 Fort Campbell Blvd - Clarksville - TN - 37042
23-44114 - ASCENSION SAINT THOMAS-URGENT CARE - E. NASH - 3024 Gallatin Pike - Nashville - TN - 37216
23-44115 - ASCENSION SAINT THOMAS-URGENT CARE - MURF WEST - 1144 Fortress Blvd - Suite K - Murfreesboro - TN - 37218
23-44117 - ASCENSION SAINT THOMAS-URGENT CARE - 1905 Gallatin Pk. North - Madison - TN - 37115
23-44118 - ASCENSION SAINT THOMAS-URGENT CARE - 650 S. Jefferson Ave - Suite 101 - Cookeville - TN - 38501
23-44119 - ASCENSION SAINT THOMAS-URGENT CARE - ST. BETH - 2147 Wilma Rudolph Blvd - Suite 102 - Clarksville - TN - 37040
23-44120 - ASCENSION SAINT THOMAS-URGENT CARE - SANGO - 2224-B Madison St. - Clarksville - TN - 37043
23-44121 - ASCENSION SAINT THOMAS-URGENT CARE - TINY TOWN - 1466 Tiny Town Rd - Suite C - Clarksville - TN - 37042
23-44123 - ASCENSION SAINT THOMAS-URGENT CARE - 509 Hillsboro Rd - Franklin - TN - 37064
23-44124 - ASCENSION SAINT THOMAS-URGENT CARE - 4726 Lebanon Rd - Hermitage - TN - 37076
23-44125 - ASCENSION SAINT THOMAS-URGENT CARE - DONELSON - 2412 Lebanon Pike - Nashville - TN - 37214
23-44126 - Ascension Saint Thomas Urgent Care - Gallatin - 710 Nashville Pk. - Suite 102 - Gallatin - TN - 37066
23-44127 - Ascension Saint Thomas Urgent Care - Mt. Juliet - 4024 N. Mt. Juliet Road - Mt. Juliet - TN - 37122
23-44128 - ASCENSION SAINT THOMAS-URGENT CARE - Dover Crossin - 1193 Fort Campbell Blvd. - Ste A - Clarksville - TN - 37042
23-44129 - Ascension Saint Thomas Urgent Care - S. Church - 3403 South Church St - Suite D - Murfreesboro - TN - 37127
25-51101 - Baptist Urgent Care - Jackson - 15 Old Humboldt Rd. - Suite D - Jackson - TN - 38305
25-51102 - Baptist Urgent Care - Bartlett - 8350 Hwy. 64 - Suite 103 - Bartlett - TN - 38133
25-51103 - Baptist Urgent Care - Collierville - 397 New Byhalia Rd. - Collierville - TN - 38017
25-51104 - Baptist Urgent Care - Germantown - 7860 Wolf River Blvd. - Germantown - TN - 38138
25-51105 - Baptist Urgent Care - Batesville - 555 Hwy. 6 East - Batesville - MS - 38606
25-51106 - Baptist Urgent Care - Horn Lake - 3040 Goodman Rd. W. - Horn Lake - MS - 38637
25-51108 - Baptist Urgent Care - Starkville - 500 Russell St. - Suite 3 - Starkville - MS - 39759
25-51109 - Baptist Urgent Care - Columbus - 1503 Hwy. 45 North - Columbus - MS - 39705
25-51110 - Baptist Urgent Care - West Point - 7474 Hwy. 45 Alt. N. - West Point - MS - 39773
25-51111 - Baptist Urgent Care - Saltillo (Tupelo) - 1154 Cross Creek Dr. - Saltillo - MS - 38866
25-51112 - Baptist Urgent Care - Wynne - 411 S. Falls Blvd. - Wynne - AR - 72396
Corporate - Urgent Team - 30 Burton Hills Blvd - Suite 175 - Nashville - TN - 37215
APPROVER INFORMATION
DO/SM
*
Alyssa Fisher
April Goodloe
Arianna Heras
Anna Snider
Amy Burroughs
Ashley Cahill Nhong
Belinda Bridges
Beverly Lovelady
Brian Miller
Belinda Bridges
Cindy Carter
Curt Marshall
Jason Burns
Jamie Erwin
Jennifer Caraway
Jeff Bright
Justin Poole
Laura Wilson
Melissa Scurlock
Michelle Stevens
Payton Givens
Randa Bean
Romana Rasinar
DVP Approver
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Mike Dupuis - mdupuis@urgentteam.com
Nancy Becker - nbecker@urgentteam.com
Joe House - jhouse@urgentteam.com
Does the Approver need access to print site?
*
Yes
No
Which brands do they need access to?
*
Notes